Orthopedics Billing in Virginia

Workers compensation is a large share of the book, and it is billed to a state fee schedule rather than to your contracted rates. In Virginia that plays out against a specific set of rules rather than a general one.

Claims for Virginia providers are adjudicated by Palmetto GBA (JM), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.

Coding driver

Global surgical periods and modifier use, where a post-operative visit billed separately is a denial by design.

Medicare contractor

Palmetto GBA (JM)

Medicaid program

Cardinal Care

Auto injuries

Tort state — health plan sequencing applies

What changes in Virginia

Medicaid in Virginia runs as Cardinal Care and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.

Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our own pricing in Virginia is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.

Where orthopedics claims fail

Services inside a global period billed separately
Missing or unsupported modifier on staged procedures
Comp claims billed at commercial rates

We work the claims. You practice medicine.

Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.

Call (409) 880-5990 Book a Free Consultation

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How It Works

Review

We look at your Virginia orthopedics denials.

Scope

A written scope and price before any work starts.

Transition

Coding and submission move across without a gap.

Report

Denial causes segmented by payer and provider.